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Roberts M, Popovich M, Almeida A. The Evaluation and Management of Concussion to Optimize Safe Recovery. Prim Care 2024; 51:269-282. [PMID: 38692774 DOI: 10.1016/j.pop.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Concussion is a mild traumatic brain injury causing temporary neurologic dysfunction. Symptoms following concussion are variable and generally are expected to resolve within about 1 month, but some patients experience persistent and prolonged symptoms. An early return to safe, symptom-limited activity is now favored, using targeted rehabilitation and treatments. Accommodations may be needed to facilitate return-to-school and work following concussion. Athletes should not be cleared for a full return to sport until they have recovered from a concussion and completed a return-to-play progression, in addition to returning to work/school fully.
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Affiliation(s)
- Mark Roberts
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA
| | - Michael Popovich
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA.
| | - Andrea Almeida
- Department of Neurology, University of Michigan, 2901 Hubbard Road, Suite 2723, Ann Arbor, MI 48109, USA
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Gaudiani MA, Castle JP, Wolterink TD, Sprys-Tellner TJ, Haan JW, Sean Lynch T. Analysis of Player Performance and Financial Costs Associated With Implementation of an Updated National Hockey League Concussion Protocol: A Retrospective Comparative Study. Orthop J Sports Med 2024; 12:23259671241231757. [PMID: 38665385 PMCID: PMC11044774 DOI: 10.1177/23259671241231757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/23/2023] [Indexed: 04/28/2024] Open
Abstract
Background An updated National Hockey League (NHL) concussion protocol (NHLCP) was established in the 2016-2017 season to mitigate the negative outcomes of sport-related concussions. However, few studies on the effects of implementing the NHLCP have been performed. Purpose To define concussion incidence and investigate differences in NHL player performance after a concussion during periods before and after NHLCP implementation and assess the financial impact on NHL teams associated with NHLCP implementation. Study Design Cohort study; Level of evidence, 3. Methods This was a retrospective review of NHL players who sustained a concussion before (2000-2001 to 2015-2016 seasons) and after (2016-2017 to 2020-2021 seasons) implementing the NHLCP (pre-NHLCP and post-NHLCP groups). For each group, multiple performance metrics-including 30 days, 1 season, and 3 seasons before and after concussion-were compared for both groups. Return to play, total concussion cost, and association of return to play with cost were investigated using regression analysis. Results A total of 452 players (423 skaters, 29 goalies) sustained concussions during the study period, including 331 players (315 skaters, 16 goalies) in the pre-NHLCP group and 121 players (108 skaters, 13 goalies) in the post-NHLCP group. For both groups, no significant differences in standard performance were observed during the 30-day and 1-season periods before and after concussion. The mean return to play was significantly higher in the pre-NHLCP group than in the post-NHLCP group (20.1 vs 15.7 days; P = .022). The mean adjusted player salary was not different between groups; nonetheless, the mean adjusted replacement player salary was significantly higher in the post-NHLCP group ($744,505 vs $896,942; P = .032). The mean cost of time missed did not differ between groups. The mean return to play time significantly decreased over the entire study period (R2 = 0.33; P = .005), and the mean return to play time was positively associated with cost R2 = 0.215; P = .030). Conclusion Concussion incidence did not change after implementation of the updated NHLCP; nonetheless, players had significantly less missed time from injury after protocol implementation. Changes in player performance 30 days and 1 year before and after concussion injury were not different before and after NHLCP implementation. No differences were found in the financial cost of concussions between the pre- and post-NHLCP groups, and missed time was significantly correlated with mean cost from missed time.
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Affiliation(s)
- Michael A. Gaudiani
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
| | - Joshua P. Castle
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
| | | | | | - Jager W. Haan
- College of Human Medicine, Michigan State University, Michigan, USA
| | - T. Sean Lynch
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, Michigan, USA
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Gaudiani MA, Castle JP, Easton MK, Sprys-Tellner TJ, Wolterink TD, Haan JW, George GF, Wager SG, Lynch TS, Berger RJ. Return to Play, Performance, and Earnings Analysis After Lumbar Disc Herniation in National Hockey League Players. Global Spine J 2024:21925682241232338. [PMID: 38330937 DOI: 10.1177/21925682241232338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE Professional hockey players have a high incidence of lumbar disc herniations (LDH). The purpose of this study was to determine the impact of LDH on the performance and financial earnings of National Hockey League (NHL) players. METHODS NHL players who sustained a LDH were retrospectively reviewed utilizing an online database and a 2:1 matched control cohort. Player performance and game usage was compared at one- and three-season(s) pre- and post-injury season within the cohorts. Injured and matched players were divided into 3 groups based on the player's adjusted index season salary. RESULTS A total of 181 players were included, with 62 LDH players matched to 119 healthy controls. Return to play after LDH was 79%. The LDH cohort had fewer seasons played throughout their career compared to the matched group (12.5 ± 4.3 vs 14.2 ± 3.8; P = .031). At 1 season post-index, the LDH cohort had significantly fewer goals per 60 and points per 60 when compared to pre-index. At 3 seasons post-index, the LDH cohort exhibited a significant decline in time-on-ice per game played, goals per 60, and points per 60 compared to pre-index. CONCLUSION The majority of NHL players who sustained a LDH returned to play (79%) but had shorter careers overall and decreased performance outcomes when compared to matched cohorts at both 1 and 3 seasons post-injury.
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Affiliation(s)
| | - Joshua P Castle
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Matthew K Easton
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | | | | | - Jager W Haan
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Gary F George
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Susan G Wager
- Wayne State University School of Medicine, Detroit, MI, USA
| | - T Sean Lynch
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Ryan J Berger
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
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Bretzin AC, Schmitt AJ, Teel E, Holmes JH, Wiebe DJ, Beidler E. Parent and Youth Athlete Perceptions of Concussion Injury: Establishing a Factor Structure. Arch Clin Neuropsychol 2024:acad109. [PMID: 38244578 DOI: 10.1093/arclin/acad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE The first objective was to establish the respective factor structures of a concussion perceptions inventory that was adapted for youth athletes (ages 8-14 years) and their parents from the Perceptions of Concussion Inventory for Athletes. The second objective was to understand the associations between the concussion perceptions of youth athlete-parent dyads. METHOD In this cross-sectional study, 329 parent-youth athlete dyads completed a respective concussion perception inventory. Mean age of youth respondents was 10.9 ± 1.8 years (70.1% male) and mean age of parent respondents was 40.5 ± 13.6 years (60.9% female). RESULTS Exploratory factor analyses revealed unique 7-factor structures for both the youth athlete and parent inventories (youth athlete: anxiety, clarity, treatment, permanent injury, symptom variability, long-term outcomes, and personal control; parent: anxiety, clarity, treatment, permanent injury, symptom variability, and long-term outcomes, and affect others). Weak associations were found between dyads on the 5 factors that were composed of identical items (anxiety, clarity, treatment, permanent injury, and symptom variability). CONCLUSIONS Findings suggest that this adapted inventory has adequate psychometric properties to be used in the study of the concussion perceptions of youth athletes and their parents. Weak correlations across the concussion perceptions in the dyads suggest that parents and children hold different concussion perceptions and this should be considered in instrument selection of future studies.
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Affiliation(s)
- Abigail C Bretzin
- Emergency Medicine, Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Ara J Schmitt
- Department of Counselor Education and School Psychology, Duquesne University, Pittsburgh, PA, USA
| | - Elizabeth Teel
- Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - John H Holmes
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | - Douglas J Wiebe
- Emergency Medicine, Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - Erica Beidler
- Athletic Training, Duquesne University, Pittsburgh, PA, USA
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Russell K, Walld R, Bolton JM, Chateau D, Ellis MJ. Incidence of Subsequent Mental Health Disorders and Social Adversity Following Pediatric Concussion: A Longitudinal, Population-Based Study. J Pediatr 2023; 259:113436. [PMID: 37088182 DOI: 10.1016/j.jpeds.2023.113436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 02/28/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE To determine the long-term risk of new adverse psychosocial outcomes among adolescents diagnosed with a concussion compared with those not diagnosed. STUDY DESIGN A retrospective, population-based cohort study was conducted. Adolescents (10-18 years) with a physician-diagnosed concussion between 2000 and 2005 were matched on neighborhood and age with 5 controls without concussion from the general population. New-onset mental health disorders, medication use, social, and justice outcomes were extracted using datasets linked to the population data repository. Adolescents were followed for 11-16 years. Adjusted hazard ratios (95% CIs) were estimated. RESULTS In total, 2082 adolescents with a concussion were matched to 10 510 without. Adolescents with a concussion had an increased risk of any mental health disorder (HR 1.34; 95% CI 1.25-1.45), mood disorder (HR 1.30; 95% 1.18-1.43), psychosis (HR 1.43; 95% CI 1.18-1.74), substance abuse disorder (HR 1.67; 95% 1.31-2.14), and receiving a psychotropic prescription (HR 1.31; 95% CI 1.20-1.42). Female adolescents had an increased risk of ADHD following concussion (HR 1.89; 95% CI 1.17-3.05). Adolescents with a concussion had an increased risk of being accused (HR 1.22; 95% CI 1.11-1.34), victim (HR 1.29; 95% CI 1.11-1.48), or witness (HR 1.16; 95% CI 1.01-1.32) of a crime, or contact with Child and Family Services (HR 1.33; 95% CI 1.10-1.62). There was no association between concussion and attempting or completing suicide, receiving housing support, or collecting income support. CONCLUSIONS Concussion was associated with an increased risk for multiple adverse psychosocial outcomes. Future work should focus on early identification of those at risk of these outcomes to help optimize longitudinal medical care and support.
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Affiliation(s)
- Kelly Russell
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; Excellence in Neurodevelopment and Rehabilitation Research in Child Health Research Theme - Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
| | - Randy Walld
- Manitoba Center for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James M Bolton
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Daniel Chateau
- Manitoba Center for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Michael J Ellis
- Department of Surgery, Section of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada; Pan Am Concussion Program, Winnipeg, Manitoba, Canada
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Abbott A, Ramos T, Smith WAR, Ierulli VK, Mulcahey MK. Concussion Education for Athletes: Symptom Reporting and Safe Return to Sport. JBJS Rev 2023; 11:01874474-202306000-00013. [PMID: 37327353 DOI: 10.2106/jbjs.rvw.23.00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
» Educational programs on concussion have been demonstrated to improve knowledge for athletes, families, athletic trainers, and coaches about concussion, with the goal of reducing concussion incidence, duration, severity, and complications.» Despite the widespread availability and often mandatory concussion education provided to high school and collegiate athletes, there has not been an adequate change in knowledge, attitudes, and self-reporting behavior in this population.» Recently published studies suggest improving concussion education by emphasizing athletes' symptom reporting behavior, to contrast with current emphasis on knowledge-based outcomes.» Future educational programs about concussions for athletes, families, athletic trainers, and coaches should aim to emphasize cultural and behavioral changes that demonstrate outcome changes rather than solely evaluating knowledge improvements to determine effective programming.
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Affiliation(s)
| | - Tolulope Ramos
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Wyatt A R Smith
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Victoria K Ierulli
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana
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Ganga A, Kim EJ, Araia ES, Hagan M, Shao B, Svokos K, Klinge PM, Cielo DJ, Fridley JS, Gokaslan ZL, Toms SA, Sullivan PZ. Pediatric all-terrain vehicle (ATV) related head injury rates and patterns: A 10-year nationwide analysis. Am J Emerg Med 2023; 67:56-62. [PMID: 36804750 DOI: 10.1016/j.ajem.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/23/2022] [Accepted: 02/07/2023] [Indexed: 02/12/2023] Open
Abstract
INTRODUCTION The use of all-terrain vehicles (ATVs) carries significant risk of permanent injury and death, disproportionately affecting children. These injuries commonly affect the head and are especially severe among children as they are often unhelmeted and more likely than adults to experience rollover injuries. Many studies examining patients with ATV-related injuries are single-center cohort studies, with few focusing specifically on head injuries. In the present study, we aimed to characterize the annual incidence of ATV-related head injuries between 2012 and 2021, classify and compare head injury types, and identify descriptive characteristics of ATV-related head injury victims. METHODS Using the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) database, we queried all head injuries associated with operating or riding an ATV in children under 18 years-old from over 100 emergency departments (EDs). Patient information regarding age, race, sex, location of incident, diagnoses, and sequelae were analyzed. We also collected the estimated number of ATV-related head injuries from all US EDs using the NEISS algorithm provided by the database. RESULTS Using the NEISS algorithm we identified 67,957 (95% CI: 43,608 - 92,305) total pediatric ATV-related head injuries between 2012 and 2021. The annual incidence of ATV-related head injury was similar throughout this study period except for a 20% increase during the COVID-19 pandemic period of 2019-2021 (2019: 6382 injuries, 2020: 6757 injuries, 2021: 7600 injuries). A subset of 1890 cases from approximately 100 EDs were then analyzed. Unspecified closed head injuries were the prevailing type of injury (38%, 900/1890), followed by concussions (27%, 510/1890). More severe injuries included intracranial hemorrhages in 91 children (3.8%, 91/1890). Injuries of all types were predominantly seen in 14-17 year-old's (780/1890, 41%) and in males (64.1%, 1211/1890). In addition, ATV-associated injuries were significantly more common in those coded as white (58.0%, 1096/1890) than any other racial group. ATV-associated accidents among children younger than 9 more commonly occurred at the home compared to accidents involving children older than 9 (57% vs. 32%, p < 0.0001). CONCLUSION ATV-related head injuries cause a significant annual burden among children, with growing incidence in recent years. Further research may wish to explore potential benefits of helmet use and supervision of younger children in possible prevention of these accidents and their associated economic and non-economic costs.
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Affiliation(s)
- Arjun Ganga
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Eric J Kim
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Ermias S Araia
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Matthew Hagan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Belinda Shao
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Konstantina Svokos
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Petra M Klinge
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Deus J Cielo
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Jared S Fridley
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Ziya L Gokaslan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Steven A Toms
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America
| | - Patricia Zadnik Sullivan
- Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America; Department of Neurosurgery, Warren Alpert School of Medicine, Brown University, Providence, RI 02903, United States of America.
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Roby PR, Podolak OE, Grady M, Arbogast KB, Master CL. The effect of a home exercise program on visio-vestibular function in concussed pediatric patients. Front Sports Act Living 2023; 5:1064771. [PMID: 36935886 PMCID: PMC10020172 DOI: 10.3389/fspor.2023.1064771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Background A visio-vestibular home exercise program (VV-HEP) can provide an equitable and cost-effective method for therapy targeted towards visio-vestibular deficits that are common following concussion. The effects of a VV-HEP on improving concussion symptoms and visio-vestibular function are unclear. Purpose Determine the effect of VV-HEP on symptoms and visio-vestibular function in concussed pediatric patients. Methods This study included 527 patients [294 female (55.8%); age = 14.4 ± 2.1 years] reporting to a specialty care concussion center within 28 days of injury and for a first follow-up within 60 days of injury. Patients completed the Post-Concussion Symptom Inventory (PCSI) and Visio-Vestibular Examination (VVE). Patients were prescribed the VV-HEP at initial visit, with exercises including saccades, gaze stability, convergence, and balance, and instructed to complete these 1-2 times/day. At follow-up, patients self-reported their VV-HEP progress as (1) has not done, (2) in progress, or (3) completed. Primary outcomes included VV-HEP progress at follow-up, PCSI endorsement and severity, VVE subtests (normal/abnormal), and total VVE score (abnormal = 2 + abnormal subtests). Kruskal-Wallis tests and chi-square were used to determine if concussion symptoms or the proportion of abnormal VVE outcomes, respectively, were associated with VV-HEP status. Post-hoc pairwise comparisons with Bonferonni corrections were used to determine concussion symptom (α = 0.017 a priori) and VVE (α = 0.005 a priori) differences in VV-HEP status. Results At follow-up, patients who had completed the VV-HEP reported lower symptom endorsement (median = 1, IQR = 0-3) and lower symptom severity (median = 1, IQR = 0-4) relative to patients who had not started the VV-HEP (endorsement median = 7, IQR = 1-13, p < 0.0001; severity median = 15.5, IQR = 2-32.5, p < 0.0001) and those in progress (endorsement median = 8, IQR = 3-14, p < 0.0001; severity median = 15, IQR = 4-30, p < 0.0001). A lower proportion of patients who completed the VV-HEP reported with abnormal vestibular-ocular reflex (22.2%), tandem gait (0%), and total VVE score (22.2%) relative to those who had not started or those in progress (p < 0.005). Conclusion Our findings indicate that patients who completed the VV-HEP had lower symptom burden and improved visio-vestibular function relative to those who did not start or were in progress. This suggests that a VV-HEP can effectively reduce visio-vestibular dysfunction following concussion and may serve as a means to minimize inequities in access to care.
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Affiliation(s)
- Patricia R. Roby
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Olivia E. Podolak
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Matthew Grady
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Sports Medicine Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Division of Emergency Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Correspondence: Kristy B. Arbogast
| | - Christina L. Master
- Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- Sports Medicine Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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Muacevic A, Adler JR, Powers JE. The Potential Role of Neurofilament Light in Mild Traumatic Brain Injury Diagnosis: A Systematic Review. Cureus 2022; 14:e31301. [PMID: 36514599 PMCID: PMC9733779 DOI: 10.7759/cureus.31301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is an insult to the CNS often overlooked at the time of presentation due to variable symptomatology and undetectable nature on CT/MRI. Increased exposure to repetitive head injuries results in a high prevalence of mTBI among athletes and military personnel. While most patients fully recover with rest, some are at risk for long-lasting neurocognitive dysfunction, leading to a high morbidity and cost burden on the healthcare system. Currently, there are no unified symptom-based criteria or gold standard objective measurement for mTBI. Neurofilament light (Nf-L) is a highly sensitive biomarker for axonal injury with the potential to serve as an objective serum measurement for mTBI. This systematic review investigates the ability of Nf-L to accurately diagnose acute mTBI in athletes and military personnel. A comprehensive literature search of PubMed, Scopus, and Google Scholar from 2010 to 2021 using keywords neurofilament light chain, mTBI, concussion, athletes, and military identified 239 articles for eligibility screening. Ten articles met the inclusion criteria for qualitative analysis, with extracted data including Nf-L levels, recovery characteristics, and neuroimaging results. Of the 10 studies meeting inclusion criteria, one was military-related, five were sports-related, and four were mixed-focus. Six studies investigated the association between mTBI and Nf-L levels within 24 hours of injury. Four of these studies involved athletes, with three showing evidence of acute Nf-L elevations. No evidence of acute Nf-L elevations was reported among military personnel or emergency department patients. Nf-L elevations were recorded at various time points greater than 24 hours post-injury in athletes (two studies) and emergency department patients (one study). Positive associations were found between Nf-L levels and loss of consciousness/post-traumatic amnesia (one study), positive neuroimaging findings (three studies), and prolonged recovery times (three studies). We are unable to conclude whether Nf-L has the capacity for acute diagnosis of mTBI or the optimal time for serum measurement. Nf-L does, however, shows promise as a prognostic factor for mTBI complications, neuroimaging findings, and recovery. Additional studies are warranted, as the use of Nf-L in early diagnosis of mTBI in the future would improve clinical management while decreasing complications and healthcare costs.
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Oliver B, Ashton J, Welsby G, Simpson A. A comparison of the knowledge and attitudes of concussion within higher and lower leagues of the community rugby union game. Phys Ther Sport 2022; 58:151-159. [DOI: 10.1016/j.ptsp.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
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Chizuk HM, Cunningham A, Horn EC, Thapar RS, Willer BS, Leddy JJ, Haider MN. Association of Concussion History and Prolonged Recovery in Youth. Clin J Sport Med 2022; 32:e573-e579. [PMID: 35533140 PMCID: PMC9633345 DOI: 10.1097/jsm.0000000000001044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/28/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To determine the number of prior concussions associated with increased incidence of persistent postconcussive symptoms (PPCS) in a cohort of acutely concussed pediatric patients. DESIGN Prospective observational cohort study. SETTING Three university-affiliated concussion clinics. PARTICIPANTS Two hundred seventy participants (14.9 ± 1.9 years, 62% male, 54% with prior concussion) were assessed within 14 days of concussion and followed to clinical recovery. Participants with a second head injury before clinical recovery were excluded. MEASURES AND MAIN OUTCOME Concussion history, current injury characteristics, recovery time, and risk for prolonged recovery from current concussion. RESULTS There was no statistically significant change in PPCS risk for participants with 0, 1 or 2 prior concussions; however, participants with 3 or more prior concussions had a significantly greater risk of PPCS. Twelve participants sustained a subsequent concussion after clinical recovery from their first injury and were treated as a separate cohort. Our secondary analysis found that these participants took longer to recover and had a greater incidence of PPCS during recovery from their latest concussion. CONCLUSION Pediatric patients with a history of 3 or more concussions are at greater risk of PPCS than those with fewer than 3 prior concussions.
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Affiliation(s)
- Haley M Chizuk
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, New York
- Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo, SUNY, Buffalo, New York; and
| | - Adam Cunningham
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, New York
| | - Emily C Horn
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, New York
| | - Raj S Thapar
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, New York
| | - Barry S Willer
- Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, New York
| | - John J Leddy
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, New York
| | - Mohammad N Haider
- UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, SUNY, Buffalo, New York
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